When someone is having thoughts of suicide, a psychiatric hospital should be a place where they are kept safe: it is the reason for they exist. Psychiatric hospitals must ensure their facilities provide no opportunity for patients to cause themselves harm when they are at risk of suicide. How can it be any other way? When a hospital fails in this duty and patients suffer an experienced suicide attorney can help families to pursue legal action to recover compensation for losses the facility’s carelessness causes. A patient has a right to safety; the patient’s family has a right to know their loved one is safe.

Besides civil action, regulators can, and should, also take action against hospitals that fail their patients. It is their job to protect us. When hospitals and regulators fail to protect us, it is the duty of juries to protect us—to make our communities safe.

Facilities providing mental healthcare are often state funded or receive federal funds through Medicaid and Medicare. States can threaten their funding, and the Centers for Medicare & Medicaid Services can determine a facility should no longer continue to receive payments if it cannot provide safe patient care. Losing funding can have a major impact on whether the facility can continue operating.

Psychiatric Hospital Faces Loss of Funding

One facility at risk of losing its funding is Timberlawn Mental Health System, which is in Dallas. Officials at the facility were warned doorknobs in patient’s room might be used to hang themselves.  Despite the serious danger the door knobs presented, they were not replaced until February 19. This was two days after the first of safety inspections that occurred unannounced.

The door knobs were not the only problem. Inspections conducted by U.S. Centers for Medicare and Medicaid Services (CMS) uncovered “numerous safety problems,” according to the Dallas News.

On February 17 of last year, federal inspectors indicated there were shortcomings at the facility that left patients at Timberlawn in “immediate jeopardy.” This included things like having plastic liners in garbage cans, and telephone and electrical cords that presented a risk to psychiatric patients. Immediate jeopardy is the most serious warning CMS issues.

While the facility submitted a plan in March to remedy the issues, the changes the hospital indicated it would make came too late for one patient.  A 37-year-old who had checked herself into the facility when struggling with a dissociative disorder had died by suicide in December. Her death took place a full five months after the initial warnings about the doorknobs were issued to the facility.

Suicide attorney Skip Simpson from the Law Offices of Skip Simpson is representing the family and called failing to change the doorknobs “completely reckless.”  The Dallas Morning News quoted Simpson: “This hospital needs to go ahead and put a sign up in front of their building that says ‘Not safe for suicidal patients.”

The hospital’s reckless behavior has had a real cost. While it may make changes now, they are being forced to do so due to the threat of lost funding, those changes should have been made early so the facility could have better fulfilled its basic obligation to keep patients safe.

It should not have taken a threat to close the facility for this hospital to provide a safe environment of care: a culture of safety. Plenty of patient safety rules, for many, many years, have required psychiatric facilities to be safe. The Joint Commission requires patient safety. Doesn’t it just make sense? Texans like rules. They teach their children rules. They teach their children when rules are broken there are consequences.

Sadly a family with their daughter in this facility suffered the biggest consequence. Now Timberlawn will pay the consequences. It is just what happens in Texas. We like rules and folks playing by the rules; nothing new all over America.

Another thing we teach our children: “when you break a rule and it hurts someone or property: you make it right.” My mom said “Skip, you broke the window—admit it and pay for it.” It is just what good citizens do; yes, corporate citizens too. It is just the simple truth.

Note from the Law Offices of Skip Simpson: This extremely important blog comes from Dr. Paul Quinnett, president and CEO of The QPR Institute, Inc. Dr. Quinnett is a leading authority on suicide prevention in the United States.

When I started writing this blog, the country was still shaking from the shootings at UC Santa Barbara. Before I finished the first draft, the shooting at Seattle Pacific University had just ended. I am in rewrite today, one day after the tragedy in Las Vegas, and while writing this very sentence I learned of the shooting in Troutdale, Oregon.

Full stop!

America, we need to call a timeout, huddle up, and get an action plan going to stop the carnage.

To prevent the next mass murder-suicide we must, simply must, get upstream from these unfolding events and identify potential suicidal shooters before they purchase weapons, load up, and open fire. Yes, suicidal shooters, not homicidal ones.

I’ve covered this a bit in earlier posts, but bear with me. If suicide contagion is real (and it is), then so is murder-suicide contagion. See one, do one. Humans are highly imitative primates – and not just of good manners, but murder, means and mayhem.

For schools and colleges, one intervention recommended by some is to arm school employees, from teachers to school safety officers, and even students themselves. Armed resistance may reduce the number of persons killed and injured, but in my view it is too little too late. When bullets begin to fly, you’re into intervention, not prevention.

Stopping smoking is prevention; heart surgery is intervention. An armed employee or student can respond to an attack – if they are not killed first – but the homicidal-suicidal person who knows an armed target awaits him at his chosen location is likely to be attracted, not dissuaded, from action. His solution, after all, is to die in a hail of gunfire.

Mass murder-suicides (from Virginia Tech to Sandy Hook to UCSB to Las Vegas) are perpetrated by people who are suicidal first, homicidal second. Once the decision to die has been made – either by their own hand or by another’s – the second decision to seek “justice” for perceived wrongs provides only a final motivation.

Ways to Prevent Mass Murder-Suicides

These are not random acts of violence. Escapes are not planned. The shooter’s intention is to die, usually at the scene. Mass murder-suicides are premeditated, planned, and therefore preventable – if three things are done:

1. Train as many people as possible to recognize and respond to suicide warning signs. This is our collective responsibility to assure ourselves of a safe and sane society. On expert retrospective analysis of these events, suicide warning signs are inevitably present before the shooting begins. Suicide warning signs can be taught and acted upon to cause a formal threat assessment to be conducted, perhaps followed by voluntary or involuntary treatment or other risk mitigation interventions, e.g., denying access to firearms.

2. Train mental health professionals. Currently, few mental health professionals are well trained in how to conduct a comprehensive suicide/homicide risk assessment. Moreover, too many do not routinely intervene with families to see to the removal or security of firearms available to potential suicidal or homicidal loved ones. Thus, even though a potential shooter is in treatment, there is no guarantee a competent risk assessment has been conducted or that all evidence-based risk mitigation strategies have been employed, including restricting access to firearms.

The training, by the way, is called Counseling Against Access to Lethal Means (CALM) and it is available free at: http://training.sprc.org/. It was developed by a dear colleague and friend and I cannot recommend it too highly. If you own a gun, you have a new duty: take CALM training.

3. Train law enforcement officers. Police officers are likewise not well trained to recognize and respond thoroughly to suicide warning signs. If they do detain a person for evaluation, they must rely on emergency room or mental health professionals to determine the level of risk and necessary action steps. But research shows that ED staffers know even less about suicide/homicide risk assessment than do mental health professionals. In the UCSB case, after a 10-minute welfare check, the sheriffs left a number and encouraged Elliot Rodger to call for help.

He didn’t.

Wake up, people…. suicidal males rarely ask for help, and homicidal-suicidal males never do. Or if they do, it is when taking the first steps down the trail to a tragedy for all.

Rarely Do Suicidal Males Ask for Help

This step might be taken in a therapist’s office, or in a conversation with a school counselor, or with someone who might, just might, be in a position to recognize that small but ominous cloud rising from a sea of mental anguish and torment “no bigger than a man’s hand.”

I am, admittedly, an impatient man. Waiting for troubled, angry, suicidal young men to ask for help before they start killing us is unacceptable. Enough with the waiting. If we have satellite spy cameras so powerful we can read a license plate from space, surely we are smart enough to figure out how to identify these people before they gain access to guns and start shooting.

(To my fellow Americans in the NSA reading this blog post: How about lending us all a hand here?  As tax payers, you work for us not the other way around, right?)

Back to the cops who, in this case, and in my view, might have tried the slick Lt. Colombo maneuver to get into the shooter’s house without a warrant, as in, “Oh, by the way… I wonder if it would be OK if we looked around just to make sure, etc. etc.” Stiff resistance to this polite request would raise the index of suspicion and perhaps trigger a deeper investigation.

Mental Health/Law Enforcement Teams

If police officers cannot be trained to detect suicide risk, and then conduct suicide/homicide risk assessments in the field, then pair them with trained mental health professionals and create competent, quick-acting crisis response teams who understand that early identification and intervention may go unrewarded by the general public, but is still heroic. Mental health/law enforcement teams must be fully funded to respond to these threats and yet, currently, many communities are without them.

In the UCSB tragedy it is clear that the two groups of professionals who had contact with Mr. Rodger before he started killing people did not, or could not, communicate with each other about the risk that alarmed his parents and a roommate. The parents acted, but the roommate did not, later saying, “Why did I not say anything?”

The parents did say something, but we can only guess that the professionals involved may not have had the kind of training needed to a) recognize suicide/homicide warning signs, b) conduct a comprehensive suicide/threat assessment, and c) employ their collective civil authority to cause a change in the trajectory of the unfolding event, e.g., a voluntary or involuntary hospital hold to determine how much risk to self and others was present.

It’s a cheap shot for me to opine about this UCSB event while unencumbered by the facts, or the reality of actually having been there, but I have reviewed all of the other high-profile mass-murder suicides in recent history and the pattern is the same again and again and again. And as an old spy myself (retired), I have a pretty good idea of what’s missing. It’s called Intel.

From the 1955 Hoover Commission on American spy work, “Intelligence deals with all the things which should be known in advance of initiating a course of action.” Intelligence is used to prevent violence, and we cannot expect our mental health and law enforcement officers to initiate a course of action to avert violence without better intelligence. The dots are there; they are just not being connected.

But what about confidentiality?

What confidentiality? When lives are at stake, confidentiality is moot.

Too often confidentiality is the screen behind which mental health professionals stand to protect themselves from extra work, like talking to parents or family members when conducting a youth suicide risk assessment. Yes, they don’t get paid for intelligence gathering beyond that provided by their patients, but they should, and this can be fixed with a stroke of the regulatory pen.

Any clinician who relies solely on the statements made by a suicidal and possibly homicidal patient to assess and manage potential risk for violence is either untrained or naive. (Sometime I will share my Top 10 Reasons to Lie to Your Therapist if You Are Suicidal).

When I directed a large emergency service for 25 years and had the authority to invoke involuntary detention to determine if treatment was indicated for anyone suicidal or homicidal or both, people sometimes threatened to sue us over their loss of privacy. None did. But if they had, I was fully prepared to make the case for a temporary suspension of a person’s civil rights in the name of safety for all.

Some say these mass murder-suicides are unpredictable and therefore cannot be prevented. I disagree.  The dots are all there. Through training, education, better intelligence gathering, better intelligence sharing, and better communication among observers, we’ve shown we can greatly reduce American battlefield causalities. Now all we have to do is apply what we already know how do in our own back yards.

A suicide attorney at the Law Offices of Skip Simpson can help. Call (214) 618-8222 to schedule a free case consultation.